TRIAL OF SCAR AND VAGINAL BIRTH AFTER CAESAREAN SECTION
AbstractBackground: The caesarean section rate has increased to an alarming extent in the last three decades the world over and fear of rupture of uterus in subsequent pregnancy and labour has led to a high rate of repeat caesarean sections. The objective of this study was to determine the final outcome of a trial of scar and Vaginal Birth After Caesarean Section (VBAC) and develop guidelines to reduce the rate of unnecessary repeat caesarean section. Methods: This study was carried out in Obstetric and Gynecology Unit ‘A’ of Ayub Teaching Hospital Abbottabad from 01.11.2002 to 31.10.2004. A total of 2652 patients were delivered during this period, out of which 297 patients had history of one previous caesarean section. A total of 53 patients had an elective repeat caesarean section and rest of 244 was subjected to a trial of scar. Result: Out of 244 patients selected for trial of scar, 165 (67.2%) had a successful uncomplicated vaginal delivery, 7 (3.2%) were delivered by forceps, 11 (5.2%) with vacuum extractor and 61 (24.4%) required a repeat emergency caesarean section. 83% of the patients had a spontaneous onset of labour and 17% needed induction of labour with prostaglandin E2 pesseries and augmentation of the labour with oxytocin. However repeat caesarean section rate was high in the later group. 71.2% of the babies were born with Apgar score > 8 and 24.6% had an Apgar score between 6-8. There were 3 cases of scar dehiscence and one case of ruptured uterus and one baby was lost due to this complication. No serious maternal complication occurred. Conclusions: More than 75% of the patients with previous one caesarean section for non-recurrent cause can be successfully delivered vaginally. Antenatal booking and follow up, careful case selection for trial of scar and close observations during labour will achieve successful maternal and perinatal outcome. VBAC also saves any future caesarean sections, as currently previous two caesarean sections is an indication for elective caesarean section. Key wards: Trial of Scar, Cesarean Section Rate, VBAC,
Paul-RH, Miller-DA. Caesarean birth: how to reduce the rate. Am J Obstet Gynaecol 1995:172(6)1903-7
Gyamfi C, Juhasz G, Gyamfi P, Stone JL. Increased success of trial of labor after previous vaginal birth after cesarean section. Obstet Gynecol 2004;104(4):715-9.
Van Bogaert LJ. Mode of delivery after one cesarean section. Int J Gynaecol Obstet 2004;87(1):9-13.
Durnwald C, Mercer B. Vaginal birth after Cesarean delivery: predicting success, risks of failure. J Matern Fetal Neonatal Med 2004;15(6):388-93.
Martel MJ, Mackinnon CJ. Guidelines for vaginal birth after precious Caesarean birth. J Obstet Gynaecol Can 2004;26(7):660-83..
Abu-Haija AT. Vaginal birth after one previous caesarean section: a Jordanian experience. J Obstet Gynaecol 1995;21(1):9-12
Lieberman E, Ernst EK, Flamm B. Results of the national study of vaginal of birth after cesarean in birth centers. Obstet Gynecol 2004;104(5):933-42.
Weinstein D, Benshushan A, Tanops V. Predictive Score of vaginal birth after caesarean section. AmJ Obstet Gynaecol 1996;174(1 pt 1):192-8.
Savag W, Francome C. British Caesarean Section Rate: have we reached a plateau? Br J Obstet Gynaecol 1993;100:493-6
Lovell R. Vaginal delivery after Caesarean section: factors influencing success rates. Aust NZ J Obstet Gyynaecol 1996;36(1):4-8
Turnquest MA, James T, Marcell C. Vaginal birth after caesarean section in a university setting. J Ky Med Asoc 1994; 92(6):216-21
Harrington LC, Millar DA, McClain CJ. Vaginal birth after caesarean in a hospital based birth center staffed by certified nurse midwives. J Nurse Midwefery 1997;42(4):304-7.
Cerda Hinojosa J. Benavides de Anda L, Martinez Delgado E. Care of delivery following a caesarean section. Gynecol Obstet 1994; 62:312-4
Bujold E, Blackwell SC, Hendler L, Gauthier RJ. Modified Bishop’s score and induction of labor in patients with a previous cesarean delivery. Am J Obstet Gynecol 2004;191(5):1644-8.
Kumar S, Maouris P. Induction of labour for trial of vaginal birth after Caesarean Section in a remote District Hospital. Aust NZJ Obstet Gynaecol 1996;36(4) 417-20.
Roberts LJ, Beardsworths SA. Labour following caesarean section: current practice in the United Kingdom. Br J Obstet Gynaecol 1994;101:153-5.
Derom R, Patel NB, Thiery M. Implication of increasing rates of Caesarean Section. In: John Studd editor. Progress in Obstetrics and Gynaecology. 6. Newyork;Churchill Livingstone. 1993: 183.
Dickinson JE. Previous Caesarean Section. A High Risk Pregnancy. James DK eds. Philadelphia; WB Saunders Co 1996; 207-8
Creighton SM, Pearce JM, Stanton SL., Complications of Caesarean Section, In: John Studd. Editor: Progress in Obstetrics and Gynaecology. Newyork; Churchill Livingstone 1994;172
Murthy KS. The role of postnatal x-ray pelvimetry after caesarean section in management of subsequent delivery. Br J Obstet Gynaecol 1991;98:716-8
Bhubishi M. Vaginal delivery after previous caesarean section: is x-ray pelvimetry necessary? Br J Obstet Gynaecol 1993;100:421-4
Rosen MG, Dickinson JC, Westhoff CL. Vaginal birth after caesarean section: A meta-analysis of morbidity and mortality. Obstetric and Gynaecology 1991;77: 465-70